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==User dependence==
Different methods require different levels of diligence by users. Methods with little or nothing to do or remember, or that require a clinic visit less than once per year are said to be ''non-user dependent'', ''forgettable'' or ''top-tier'' methods.<ref name="Hatcher20th">{{cite book |editor1-last=Hatcher |editor1-first=Robert A. |editor2-first=James |editor2-last=Trussell |editor3-first=Anita L. |editor3-last=Nelson | name-list-style = vanc |title=Contraceptive Technology |publisher=Ardent Media |___location=New York |year=2011 |edition=20th |isbn=978-1-59708-004-0}}{{page needed|date=June 2012}}</ref> Intrauterine methods, implants, and sterilization fall into this category.<ref name="Hatcher20th" /> For methods that are not user dependent, the actual and perfect-use failure rates are very similar.
Many hormonal methods of birth control, and LAM require a moderate level of thoughtfulness. For many hormonal methods, clinic visits must be made every three months to a year to renew the prescription. The pill must be taken every day, the patch must be reapplied weekly, or the ring must be replaced monthly. Injections are required every 12 weeks. The rules for LAM must be followed every day. Both LAM and hormonal methods provide a reduced level of protection against pregnancy if they are occasionally used incorrectly (rarely going longer than 4–6 hours between breastfeeds, a late pill or injection, or forgetting to replace a patch or ring on time). The actual failure rates for LAM and hormonal methods are somewhat higher than the perfect-use failure rates.
Higher levels of user commitment are required for other methods.<ref name=WHOTable>{{cite report|title = Helping women understand contraceptive effectiveness | first1 = Kathleen Henry | last1 = Shears | first2 = Kerry Wright | last2 = Aradhya | name-list-style = vanc | url = http://www.fhi.org/NR/rdonlyres/eoabicg5w53xarcybsiefba5ruvr6r2dnkws7vj2hr3ndzv225gkvw2oxtkdlxzcl5yr3q3iok4kid/Mera08091.pdf | date = July 2008 | publisher = Family Health International}}</ref> Barrier methods, coitus interruptus, and spermicides must be used at every act of intercourse. Fertility awareness-based methods may require daily tracking of the menstrual cycle. The actual failure rates for these methods may be much higher than the perfect-use failure rates.<ref name="trussell2007body">{{cite book |last=Trussell |first=James |editor1-last=Hatcher |editor1-first=Robert A. |editor2-first=James |editor2-last=Trussell |editor3-first=Anita L. |editor3-last=Nelson |name-list-style=vanc |year=2007 |chapter=Contraceptive Efficacy |title=Contraceptive Technology |edition=19th |___location=New York |publisher=Ardent Media |isbn=978-0-9664902-0-6 |chapter-url=http://www.contraceptivetechnology.org/table.html |url-access=registration |url=https://archive.org/details/contraceptivetec00hatc }}{{page needed|date=June 2012}}</ref><!-- NOTE: This reference is to the same work as is referred to in the table, but the table has a separate reference list, so do not remove the body of this reference -->
==Side effects==
Different forms of birth control have different potential side effects. Not all, or even most, users will experience side effects from a method.
The less effective the method, the greater the risk of the side effects associated with pregnancy.
Minimal or no other side effects are possible with coitus interruptus, fertility awareness-based, and LAM. Some forms of periodic abstinence encourage examination of the cervix; insertion of the fingers into the vagina to perform this examination may cause changes in the vaginal environment. Following the rules for LAM may delay a woman's first post-partum menstruation beyond what would be expected from different breastfeeding practices.{{citation needed|date=April 2022}}
Barrier methods have a risk of allergic reactions. Users sensitive to latex may use barriers made of less allergenic materials - polyurethane condoms, or silicone diaphragms, for example. Barrier methods are also often combined with spermicides, which have possible side effects of genital irritation, vaginal infection, and urinary tract infection.
Sterilization procedures are generally considered to have a low risk of side effects, though some persons and organizations disagree.<!--
--><ref>{{cite web |last=Bloomquist |first=Michele | name-list-style = vanc | title = Getting Your Tubes Tied: Is this common procedure causing uncommon problems? | work = MedicineNet.com |publisher=WebMD |date=May 2000 |url=http://www.medicinenet.com/script/main/art.asp?articlekey=51216 |access-date=2006-09-25 }}</ref><ref>{{cite web |last=Hauber |first=Kevin C. | name-list-style = vanc |title=If It Works, Don't Fix It! |url=http://www.dontfixit.org/ |access-date=2006-09-25 }}{{MEDRS|date=September 2012}}</ref> Female sterilization is a more significant operation than vasectomy, and has greater risks; in industrialized nations, mortality is 4 per 100,000 tubal ligations, versus 0.1 per 100,000 vasectomies.<ref>{{cite journal | vauthors = Awsare NS, Krishnan J, Boustead GB, Hanbury DC, McNicholas TA | title = Complications of vasectomy | journal = Annals of the Royal College of Surgeons of England | volume = 87 | issue = 6 | pages = 406–10 | date = November 2005 | pmid = 16263006 | pmc = 1964127 | doi = 10.1308/003588405X71054 }}</ref>
After IUD insertion, users may experience irregular periods in the first 3–6 months with Mirena, and sometimes heavier periods and worse menstrual cramps with ParaGard. However, continuation rates are much higher with IUDs compared to non-long-acting methods.<ref>{{Cite journal|last=Committee on Practice Bulletins-Gynecology, Long-Acting Reversible Contraception Work Group|date=November 2017|title=Practice Bulletin No. 186: Long-Acting Reversible Contraception: Implants and Intrauterine Devices|url=https://www.ncbi.nlm.nih.gov/pubmed/29064972|journal=Obstetrics and Gynecology|volume=130|issue=5|pages=e251–e269|doi=10.1097/AOG.0000000000002400|issn=1873-233X|pmid=29064972|s2cid=35477591 }}</ref> A positive characteristic of IUDs is that fertility and the ability to become pregnant returns quickly once the IUD is removed.<ref name="plannedparenthood.org">{{cite web|url=http://www.plannedparenthood.org/health-topics/birth-control/iud-4245.htm|title=Planned Parenthood IUD Birth Control - Mirena IUD - ParaGard IUD|access-date=2012-02-26}}</ref>
Because of their systemic nature, hormonal methods have the largest number of possible side effects.<!--
Combined hormonal contraceptives contain estrogen and progestin hormones.<ref name=":0">{{Cite journal |last1=Teal |first1=Stephanie |last2=Edelman |first2=Alison |date=2021-12-28 |title=Contraception Selection, Effectiveness, and Adverse Effects: A Review |url=https://jamanetwork.com/journals/jama/fullarticle/2787541 |journal=JAMA |language=en |volume=326 |issue=24 |pages=2507–2518 |doi=10.1001/jama.2021.21392|pmid=34962522 |s2cid=245557522 |issn=0098-7484|doi-access=free }}</ref> They can come in formulations such as pills, vaginal rings, and transdermal patches.<ref name=":0" /> Most people who use combined hormonal contraception experience breakthrough bleeding within the first 3 months.<ref name=":0" /> Other common side effects include headaches, breast tenderness, and changes in mood.<ref name=":1">{{Cite journal |last=Barr |first=Nancy Grossman |date=December 15, 2020 |title=Managing Adverse Effects of Hormonal Contraceptives |url=https://www.aafp.org/afp/2010/1215/afp20101215p1499.pdf |journal=American Family Physician |volume=82 |issue=12 |pages=1499–1506 |pmid=21166370 |via=American Academy of Family Physicians}}</ref> Side effects from hormonal contraceptives typically disappear over time (3-5 months) with consistent use.<ref name=":1" /> Less common effects of combined hormonal contraceptives include increasing the risk of deep vein thrombosis to 2 to 10 per 10 000 women per year and venous thrombotic events (see [[venous thrombosis]]) to 7 to 10 per 10,000 women per year.<ref name=":0" />
Hormonal contraceptives can come in multiple forms including injectables. Depot medroxyprogesterone acetate (DMPA), a progestin-only injectable, has been found to cause amenorrhea; however, the irregular bleeding pattern returns to normal over time.<ref name=":0" /><ref name=":1" /> DMPA has also been associated with weight gain.<ref name=":1" /> Other side effects more commonly associated with progestin-only products include [[acne]] and [[hirsutism]].<ref name=":1" /> Compared to combined hormonal contraceptives, progestin-only contraceptives typically produce a more regular bleeding pattern.<ref name=":0" />
===Sexually transmitted disease prevention===
{{main article|Safe sex}}
[[condom|Male]] and [[female condom]]s provide significant protection against [[sexually transmitted disease]]s (STDs) when used consistently and correctly. They also provide some protection against [[cervical cancer]].<ref>{{cite journal | vauthors = Winer RL, Hughes JP, Feng Q, O'Reilly S, Kiviat NB, Holmes KK, Koutsky LA | title = Condom use and the risk of genital human papillomavirus infection in young women | journal = The New England Journal of Medicine | volume = 354 | issue = 25 | pages = 2645–54 | date = June 2006 | pmid = 16790697 | doi = 10.1056/NEJMoa053284 }}</ref><ref name="Hogewoning2003">{{cite journal | vauthors = Hogewoning CJ, Bleeker MC, van den Brule AJ, Voorhorst FJ, Snijders PJ, Berkhof J, Westenend PJ, Meijer CJ | title = Condom use promotes regression of cervical intraepithelial neoplasia and clearance of human papillomavirus: a randomized clinical trial | journal = International Journal of Cancer | volume = 107 | issue = 5 | pages = 811–6 | date = December 2003 | pmid = 14566832 | doi = 10.1002/ijc.11474 | doi-access = free }}</ref> Condoms are often recommended as an adjunct to more effective birth control methods (such as [[IUD]]) in situations where STD protection is also desired.<ref name=DualProtection>{{cite journal | vauthors = Cates W, Steiner MJ | title = Dual protection against unintended pregnancy and sexually transmitted infections: what is the best contraceptive approach? | journal = Sexually Transmitted Diseases | volume = 29 | issue = 3 | pages = 168–74 | date = March 2002 | pmid = 11875378 | doi = 10.1097/00007435-200203000-00007 | s2cid = 42792667 }}</ref>
Other barrier methods, such as [[Diaphragm (contraceptive)|diaphragm]] may provide limited protection against infections in the upper genital tract. Other methods provide little or no protection against sexually transmitted diseases.
==Effectiveness calculation==
Failure rates may be calculated by either the [[Pearl Index]] or a [[decrement table|life table method]]. A "perfect-use" rate is where any rules of the method are rigorously followed, and (if applicable) the method is used at every act of intercourse.
Actual failure rates are higher than perfect-use rates for a variety of reasons:
In the '''user action required''' column, items that are ''non-user dependent'' (require action once per year or less) also have a blue background.
Some methods may be used simultaneously for higher effectiveness rates. For example, using condoms with spermicides the estimated perfect use failure rate would be comparable to the perfect use failure rate of the implant.<ref name="Hatcher20th" /> However, mathematically combining the rates to estimate the effectiveness of combined methods can be inaccurate, as the effectiveness of each method is not necessarily independent, except in the perfect case.<ref>{{cite journal | vauthors = Kestelman P, Trussell J | title = Efficacy of the simultaneous use of condoms and spermicides | journal = Family Planning Perspectives | volume = 23 | issue = 5 | pages = 226–7, 232 | year = 1991 | pmid = 1743276 | doi = 10.2307/2135759 | jstor = 2135759 }}</ref>
If a method is known or suspected to have been ineffective, such as a condom breaking, or a method could not be used, as is the case for [[rape]] when user action is required for every act of intercourse, [[emergency contraception]] (ECP) may be taken up to 72 to 120 hours after [[sexual intercourse]]. Emergency contraception should be taken shortly before or as soon after intercourse as possible, as its efficacy decreases with increasing delay. Although ECP is considered an emergency measure, levonorgestrel ECP taken shortly before sex may be used as a primary method for women who have sex only a few times a year and want a hormonal method, but don’t want to take hormones all the time.<ref name=shelton>{{cite journal | vauthors = Shelton JD | title = Repeat emergency contraception: facing our fears | journal = Contraception | volume = 66 | issue = 1 | pages = 15–7 | date = July 2002 | pmid = 12169375 | doi = 10.1016/S0010-7824(02)00313-X | url = https://zenodo.org/record/1259569 }}</ref> The failure rate of repeated or regular use of LNG ECP is similar to the rate for those using a barrier method.<ref name="WHO ECP Effectiveness">{{cite journal | title = Efficacy and side effects of immediate postcoital levonorgestrel used repeatedly for contraception. United Nations Development Programme/ United Nations Population Fund/World Health Organization/World Bank Special Programme of Research, Development, and Research Training in Human Reproduction, Task Force on Post-Ovulatory Methods of Fertility Regulation. vonhertzenh@who.ch | journal = Contraception | volume = 61 | issue = 5 | pages = 303–8 | date = May 2000 | pmid = 10906500 | doi = 10.1016/S0010-7824(00)00116-5 }}</ref><!-- Please make a proposal and discussion on the talk page
before making major changes to the table (e.g. adding or removing methods). -->
|-
| [[Contraceptive implant]]
| [[Implanon]]/Nexplanon,<ref name="trussell2011" /> [[Jadelle]],<ref>{{cite journal | vauthors = Sivin I, Campodonico I, Kiriwat O, Holma P, Diaz S, Wan L, Biswas A, Viegas O, el din Abdalla K, Anant MP, Pavez M, Stern J | title = The performance of levonorgestrel rod and Norplant contraceptive implants: a 5 year randomized study | journal = Human Reproduction | volume = 13 | issue = 12 | pages = 3371–8 | date = December 1998 | pmid = 9886517 | doi = 10.1093/humrep/13.12.3371 | display-authors = 8 | doi-access = free }}</ref> the implant || style="background:#e0ffff" |{{sort|000.05|0.05}} <br />(1 of 2000) || style=background:#e0ffff | {{sort|000.05|0.05}} || Progestogen || Subdermal implant || style=background:#e0ffff| {{sort | 03.000 | 3-5 years}}
|-
| [[Vasectomy]]<ref name=trussell2011/>
==Cost and cost-effectiveness==
Family planning is among the most cost-effective of all health interventions.<ref name=Tsui>{{cite journal | vauthors = Tsui AO, McDonald-Mosley R, Burke AE | title = Family planning and the burden of unintended pregnancies | journal = Epidemiologic Reviews | volume = 32 | issue = 1 | pages = 152–74 | year = 2010 | pmid = 20570955 | pmc = 3115338 | doi = 10.1093/epirev/mxq012 }}</ref> Costs of contraceptives include method costs (including supplies, office visits, training), cost of method failure ([[ectopic pregnancy]], [[Miscarriage|spontaneous abortion]], induced abortion, birth, child care expenses) and cost of side effects.<ref name=Trussell2009>{{cite journal | vauthors = Trussell J, Lalla AM, Doan QV, Reyes E, Pinto L, Gricar J | title = Cost effectiveness of contraceptives in the United States | journal = Contraception | volume = 79 | issue = 1 | pages = 5–14 | date = January 2009 | pmid = 19041435 | pmc = 3638200 | doi = 10.1016/j.contraception.2008.08.003 }}</ref> Contraception saves money by reducing [[unintended pregnancy|unintended pregnancies]] and reducing transmission of [[sexually transmitted infection]]s. By comparison, in the US, method related costs vary from nothing to about $1,000 for a year or more of reversible contraception.
During the initial five years, vasectomy is comparable in cost to the IUD. Vasectomy is much less expensive and safer than tubal ligation.
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